Anti-Adhesion Barriers

Anti-adhesion barriers are thin materials that a surgeon places to keep healing tissues apart. After pelvic surgery, raw tissue surfaces can touch while they heal. A sticky layer of fibrin, a clotting protein, forms between them. Over time, this layer can become adhesions, which are bands of scar tissue. A barrier separates the surfaces during the first days of healing. Each surface can then form a new smooth lining on its own.

Several types of barriers exist. Two types dissolve in the body over time. One is oxidized regenerated cellulose (Interceed), a treated plant fiber. The other is a sheet of sodium hyaluronate and carboxymethylcellulose (Seprafilm). Both are approved for certain abdominal and pelvic surgeries. Gels made with hyaluronic acid serve a similar purpose and spread more easily over uneven tissue. A membrane of expanded polytetrafluoroethylene (ePTFE) has also been used in reconstructive pelvic surgery. Published data show lower adhesion scores at repeat assessment when surgeons used this membrane.¹

The ePTFE membrane does not dissolve. Surgeons must suture it in place. It remains in the body unless a later surgery removes it.¹ This feature sets it apart from the dissolving barriers. The best choice of material depends on the area that needs protection, the experience of the surgeon, and what is available.

Barriers add to good surgical technique and work best alongside it. Adhesions form mainly because of tissue injury, bleeding, and poor blood flow (ischemia) at the surgical site. Careful control of bleeding and gentle tissue handling leave less raw surface where adhesions can form. Barriers then protect the raw surface that remains. In reconstructive pelvic surgery, surgeons combine barriers with careful bleeding control and gentle tissue handling. This combined approach is part of a step-by-step plan to prevent adhesions.¹

Adhesions can impair fertility and distort pelvic anatomy. For couples in this situation, adhesion prevention during surgery is important. After a surgeon releases adhesions, new adhesions can form again within weeks. The original problem can then return. A barrier is one part of a larger effort to make the results of surgery last.